NHS IT: worthwhile goals, debateable progress

Richard Granger, the director general of NHS IT, was optimistic about progress on the health service's technology-based modernisation plan when he wrote the foreword to his organisation's annual report.

Richard Granger, the director general of NHS IT, was optimistic about progress on the health service's technology-based modernisation plan when he wrote the foreword to his organisation's annual report.

He referred to the delivery of thousands of resilient and new network connections, systems that pay all GPs throughout England, assess the quality of care delivered in primary care settings, move images and patient data anywhere in the country, enable remote and instant booking of appointments, and facilities to enable the secure and accurate transmission of prescriptions.

Despite obstacles such as historic under-investment in IT in the health service, the "progress we have already achieved has exceeded expectations", said Granger.

That was in June 2005, when the annual report of Connecting for Health, the organisation that is implementing the national programme for IT (NPfIT) in the NHS, was published. Granger is chief executive of Connecting for Health.

Today, more than six months after Granger's comments were published, progress should have continued apace. But the largest survey of doctors on their reaction to the NPfIT shows that Granger has yet to convince them that all is well with the national programme.

The good news from the survey by market research firm Medix (see page 1), which was co-sponsored by Computer Weekly, is that most doctors believe that the NPfIT is likely to improve clinical care in the longer term. A few doctors echo this in their comments to Medix, indicating their view that improved IT for the NHS is a worthwhile, even essential, aim for a 21st century health service.

Still, most of the doctors who attached comments to their responses to Medix's questions were negative about aspects of the NPfIT. Their comments reflect only the views of doctors who felt strongly enough to submit a comment, not the silent majority. But the negativity of the comments reflects some of the findings of the Medix survey. Only 1% of the 1,329 respondents thought that progress so far on the NPfIT had been "good" or "excellent". 

Examples of the comments made to Medix by doctors who were willing to be named are published below. The full survey report can be found at

' www.medix-uk.com

Poor testing causes delays

"I am involved in the development of Connecting for Health in a pilot site. We have constant drift in the go live date due to poor software testing prior to installation. The clinical services have not developed at all despite offers over the last two years to engage meaningfully with the developers. They think they know what we do but show no real insight into the realities of health care. Whenever we come to a problem their idea is that we should change what we do. NPfIT/CFH should work for us. We should not work for it."

Andrew Volans, consultant, Scarborough Hospital, North Yorkshire


Long-term benefits

"I understand that we will be entering a difficult period of change, with little benefit for patients or clinicians in the short term. However, we will look back in 10 years and wonder how we ever managed without it." 

Tony Blacker, consultant urologist, Coventry


Win over the profession

"To implement what is required the profession will have to be won over and not be bullied into implementing the changes. At present there is very little incentive for the professionÉ And who will be blamed when it does not work?" 

Johnny Best, doctor, Kingston Upon Hull, Yorkshire


Communication is key

"If the people trying to introduce this spoke the same English as the rest of us we may get somewhere."

Anthony Collings, consultant physician, Southend


Lack of consultation

"There has been a complete lack of consultation with local GPs on this issue, which is unacceptable."

David Wrigley, doctor, Carnforth Lancashire


Politically driven targets

"There are too many talking shops and politically driven targets. We have yesterday been told that our new commitment to Choose and Book has been relegated to displaying a poster in the waiting room to say we offer choiceÉ This is box ticking gone mad. No doubt figures will be quoted along the lines that most GPs are offering 'Choice' when, in truth, they are not." 

Mike North, GP, Maylandsea


Waste of money

"I am using Choose and Book and think it is a total waste of money. Patients haven't heard of it, most of the hospital doctors to refer to haven't heard of it, and it is a totally poor allocation of NHS funds."

Hannah Josty, doctor, Greenwich


Positive impact on health

"[The NPfIT] will have a potentially massive positive impact on each patient's long-term health."

Pardeep Kumar, University College London Hospitals NHS Trust


Forced implementation

"Our practice has been forced into accepting Choose and Book and GP Commissioning by Rotherham Primary Care Trust. If not, we do not get our prescribing incentive monies." 

Roland Hirst, doctor, Rotherham


Good and bad elements

"Some good (Electronic Transfer of Prescriptions, GP to GP file transfers); some acceptable (Care Record Service and data spine); some ghastly (Choose and Book)." 

Peter Swinyard, doctor, Swindon


Top-down directives

"Yet again there seem to be top-down directives and an attempt to run before able to walk. Imposing IT solutions has had some spectacular failures (Wessex)."

J Miles, doctor, Wye, Kent


NPfIT will boost healthcare

"[The NPfIT] will significantly improve healthcare in patients with multiple diagnoses and help in my speciality of rheumatology, where diseases are chronic and changes may be made through out a patient lifetime."

Sonya Abraham, Kennedy Institute of Rheumatology, Imperial College London

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